Provider Demographics
NPI:1427167030
Name:EVANS, SARA THORNBURG (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:THORNBURG
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4531
Mailing Address - Country:US
Mailing Address - Phone:863-534-9383
Mailing Address - Fax:863-534-9508
Practice Address - Street 1:222 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4531
Practice Address - Country:US
Practice Address - Phone:863-534-9383
Practice Address - Fax:863-534-9508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29148ZMedicare ID - Type Unspecified
F38294Medicare UPIN